Keep On Your Feet
The Foot, Ankle & Gait Clinic
Pain & Injuries
These appointments are more in-depth and their focus is on accurate diagnosis and swift resolution of your symptoms. These appointments are suitable whether you have only just injured yourself or if you have a long-standing injury that just won't get better.
The Diagnostic Process
In order to get you out of pain, a logical process is followed. This includes taking a detailed history, a thorough physical examination and then functional tests (where appropriate). As a specialist in musculoskeletal podiatry as well as being a qualified sonographer, I also offer diagnostic injections and can do ultrasound scans in-house to expedite getting you the accurate diagnosis that you need.
Diagnosis - the history
The most important part of the treatment that you get is an accurate diagnosis. Why's that? Well, if the diagnosis is incorrect, then the treatment plan is for the wrong thing.
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How do we achieve an accurate diagnosis?
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All appointments will start by taking a detailed history. This is your opportunity to tell me exactly what is going on from your perspective.
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I dedicate a significant part of the appointment to making sure that your concerns are properly addressed and that you get to tell me the 'silly little things' that 'are probably nothing'... because I know that they aren't really 'nothing' to you, and actually, if it's important to you, it's probably important to me too!
Diagnosis - the examination
Once you've told me what's going on, I then look at the painful problem and use a detailed knowledge of human anatomy, as well as clinical tests to identify what it is that is injured.
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How do anatomy and clinical tests give the answer?
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By understanding the anatomy and how everything connects together, as well as how symptoms relate to structures like muscles, tendons and nerves, I can narrow down the cause of your pain.
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By understanding the functions that each structure has, I can also identify when the structure is injured or not functioning properly.
Diagnosis - Functional tests
Although the clinical examination is often accurate enough to tell me what structures are damaged or injured, there may be times when other techniques are required to determine how severe the problem is.
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For this, it may be necessary to do tests looking at:
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How you stand
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How you walk
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How good your balance is
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with your eyes open and closed​
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when you're standing
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when you're walking
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How much strength you have when
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standing on tip toes ​
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squatting
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jumping
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These tests will help to identify if you have flat feet or high arches when you're standing, and if this changes when you walk.
Diagnosis: advanced tests
If there is uncertainty about the diagnosis of your problem, then it may be necessary to do other tests. These tests can either be used to look inside of the body or to isolate a structure and see if that settles the pain.
Ultrasound Scans
This is a method of looking inside the body to see if there is damage or inflammation around certain structures. It is a safe method of imaging, as it uses sound waves and it can be highly effective for diagnosing fractures, torn ligaments and tendonitis.
Diagnostic Injection
Diagnostic injections work by placing local anaesthetic in or around a painful joint (or other structure) and seeing if the pain you have had disappears.
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There may be additional charges for these services.
The Treatment Process
Orthotics
Orthotics, sometimes known as insoles, are an excellent way of taking pressure and strain away from injuries. by keeping the foot stable and redistributing pressure from painful areas.
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In the short term, orthotics work like a brace to protect the injured area, helping you walk and do your daily activities without making the injury worse. This helps you get better quickly but also stops the injury from getting worse.
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In the mid-to-long term, orthotics will continue to protect your foot as it heals, allowing you to return to daily life without fear of re-injury.
The use of orthotics in the period after your injury has healed, can help to identify whether orthotics may be helpful to help manage your biomechanics in the long term.
Exercises & Rehabilitation
Exercises are an essential part of the healing process and if prescribed incorrectly can delay the healing process and also mean that you lose strength and conditioning.
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By maintaining strength in the injured limb, you will be able to return to your activities much sooner, as well as being able to protect the injured structures.
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Exercises that 'load' injured structures also stimulate healing and encourage the body to heal in a way that maximises the efficiency of those structures.
Shockwave Therapy
Shockwave therapy can be an excellent treatment for old injuries where the healing has stalled.
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Particularly useful for Achilles tendinitis, plantar fasciitis, and bone stress injuries, shockwave therapy works by re-starting the healing process and helping to tell the body where it needs to focus the healing.
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Shockwave therapy can also be really useful as it numbs the injured area making the hours or days following treatment more comfortable.
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Shockwave therapy can also be used for acute injuries, and is used before big matches and in half-time for large international football matches.
Steroid Injections
Steroids are a powerful anti-inflammatory drug, so they can be incredibly helpful for settling conditions which are inflammatory in nature.
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Steroid injections are not without risks and so, if they are to be a part of your treatment plan, they should be used with caution.
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Steroid injections will usually be given at a separate appointment once you have been identified as a good candidate for that treatment.
Steroid injections may be anatomy guided or ultrasound guided.
Gait Retraining
Gait retraining can be used for people who find that their symptoms come on whilst running.
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Following a thorough history and physical examination, you would undergo gait analysis to identify any movements that you do naturally that may be contributing to your pain.
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Gait retraining is often mistakenly thought to be a process where you are taught the way that you should run forevermore. In reality, it is very hard to train you into a new movement pattern, and so the more effective way to approach gait retraining is to see it as a way to reduce your symptoms as they come on whilst you run.
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It is possible, with targeted exercise programs, to change how you run by encouraging strengthening of muscles which assist the trained movement and, as a result, would encourage this retrained pattern to occur more naturally.
